ART STUDIO - VASILIS KYRKOS

                                   PAYMENT ORDER
                                  ---------------


Name     :...................................................................

Address  :...................................................................

Please debit my credit card:
 _          
|_| VISA
|_| AMERICAN EXPRESS
|_| MASTERCARD
|_| DINERS

Card number :.................................  Expiration date :............

for the purchase of the......................................................

................................. with the amount of .................... drs



                                               Date .................


                                                       Signature